This invention relates to compliance monitoring of hand sanitizing fluids and gels utilized to reduce the hand-borne transmission of pathogens. Disclosed is a simple, low-cost method of which a key aspect is the use of a wristband and similar worn or carried dispensers with plural individual applications of hand sanitizing fluid in a convenient dispensing format. One embodiment of the method uses a wrist-mounted dispenser that overcomes recognized and longstanding problems that contribute to inadequate hand sanitation, the single most important factor in causing nosocomial infections. To understand why professional and governmental guidelines backed by regulations have been drawn to enforce hand hygiene compliance, and how the instant invention facilitates an effective compliance monitoring method, it is necessary to appreciate the scope and nature of the health problems created by so simple a thing as unsanitary hands.
Each year more than 2 million hospital acquired infections occur in the United States, costing some $4.5 billion in additional charges. The Centers for Disease Control estimates more than one-third of healthcare associated infections can be prevented through better infection control programs of which hand cleaning is the centerpiece for reducing the spread of such infections. Hospitals are only one of many organizations burdened with hand-borne disease costs. A recent school study found that classrooms that made hand sanitizing fluid dispensers simply available for use showed a 20% reduction in student absenteeism due to illness as well as a 10% decrease in teacher absenteeism. And these are but two groups that lend themselves to study. Large population segments like commuters, food handlers, eaters, clerks, caregivers, and others share the same risks and could reasonable expect significant personal benefits from improved hand hygiene. The overall societal, economic and health impacts of hand-borne pathogens is enormous; it is the intent of the present invention to substantially curtail this debilitating circumstance by providing a low-cost, minimally invasive method of self and institutional compliance monitoring of hand hygiene.
Several recent articles provide an understanding of the current level of technology available and further describe the significant limiting problems the present art faces.
In March 2001 an American Journal of Nursing article (“Improved Rate of Compliance with Hand Antisepsis . . . ”) stated that 80,000 hospital deaths occur each year as a result of nosocomial infections contracted during their stays. Further, that “it's common knowledge that the hands of heath care workers can carry disease-causing organisms from one patient to another and that hand antisepsis before and after each patent contact is crucial to the prevention and control of nosocomial infection.” The reasons most often cited by hospital staff for failing to clean their hands adequately are inconvenience and no time. Given the hectic and demanding nature of their workload these are not excuses but simply statements of reality. That convenience and time are critical factors in maintaining hand sanitation is underscored by the finding in this study that placing hand sanitizing fluid dispensers “in the hallways outside patient rooms were nearly 30 times more likely to be used than dispensers mounted anywhere inside the rooms.” Yet the most disturbing finding of this study was that full compliance with hand antisepsis guidelines was an unrealistic goal. That while hand sanitizing fluids took less time than washing and the placement of numerous dispensers bottles made matters somewhat more convenient, even with the heightened attention impact of the study itself (the Hawthorne effect), compliance did not achieve more than 60% at any time during the study. And it is well understood that over time, after the study is done and gone, a drift back to much lower compliance rates is inevitable; the dispenser bottle becomes just one more thing in the room, like soap at the sink, to be used when time and convenience allows.
In March 2002 an article in Infection Control and Hospital Epidemiology (“Promotion of Hand Hygiene: Magic, Hype, or Scientific Challenge? ”) restates the conditions for promoting adequate hand hygiene. “Among enabling factors, engineering control must be considered for the successful promotion of hand hygiene. In particular, it involves making hand hygiene easy, convenient, and possible in a timely fashion.” Another observation made is that the higher rates of compliance seen in studies can only be sustained when some form of cost-effective, non-intrusive monitoring is invented. “My personal opinion is that obtaining a sustained and never-ending Hawthorne effect associated with improved compliance with hand hygiene and decreased infection and cross-transmission rates should be the dream of every hospital epidemiologist. Let's find a cost-effective way to induce it.” This need has remained unfulfilled until now and the instant invention.
In July 2000 another article in Infection Control and Hospital Epidemiology (“Using Alcohol for Hand Antisepsis—Dispelling Old Myths”) the qualities and values of alcohol-based hand antiseptics are described. The author points out the cost benefits of hand sanitizing fluids in hospitals. “ . . . administrators should consider that modest increase in acquisition costs for alcohol-based hand hygiene products are tiny in comparison to excess hospital costs associated with nosocomial infections. If increased use of an alcohol gel or rinse reduces the number of serious nosocomial infections by a few a year, the cost savings from prevented infections should more than offset incremental costs of using alcohol-based preparations.” These offset costs are those the hospital would charge as operational costs and are not insignificant. Another New York City Hospitals study placed the average additional cost at $35,000 per stay for just one type of pathogen, Staphylococcus aureus. Not considered are the much more substantial costs of the damage awards issuing from pain and suffering lawsuits won by patient and their attorneys for the hospital's failure to follow best practice protocols and compliance guidelines.
In March 2001 an article in Emerging Infectious Diseases (“Antiseptic Technology: Access, Affordability, and Acceptance”) further reinforces the findings that time and convenience are critical compliance factors. Detailed costs of implementing a hand hygiene program are also provided.
A final article in the October 2000 issue of Family Medicine (“Alcohol-free Instant Hand Sanitizer Reduces Elementary School Illness Absenteeism”) reports a remarkable reduction in absenteeism when hand sanitizers were introduced in public school classrooms. Results showed students using hand sanitizing fluids “were found to have 41.9% fewer illness-related absence days, representing a 28.9% and a 49.7% drop in gastrointestinal- and respiratory-related illness, respectively . . . . Conclusion: Daily use of the instant hand sanitizer was associated with significantly lower rates of illness-related absenteeism.” In this study the close monitoring and continual instruction of the test group teachers largely abrogated the issues of time and convenience. Nevertheless, it clearly indicates the significant impact consistent and rigorous hand sanitation can have in schools and the implications for parallel benefits at all levels of society are obvious. As the reports point out in describing the interlinking cost of disease “Even if one doesn't have school-age children, it is necessary to understand the importance and benefits of good hand hygiene, not only in clinical practice but also in the greater community. Vital tax dollars will be saved on expenses for remedial student services and employee work time by this simple and effective way to decrease illness-related absenteeism.”
That improved hand hygiene can be achieved by using various hand sanitizing fluids is beyond question; the problems preventing this known technique for achieving a high degree of use (compliance) are equally understood as being time and convenience. The instant invention of a novel compliance monitoring method is perforce based on a new form of dispenser of hand sanitizing fluid that mitigates the problems of time and convenience. A compact wrist mounted at hand package dispensing unitized hand sanitizing fluids largely overcome these twin problems and its inherent design features facilitates compliance monitoring.
This device in its many embodiments is the subject of a pending U.S. patent application Ser. No. (10/340,478) by William Harper. At its elemental base that applied for invention can be simply described as attaching a container of hand sanitizing fluid to the user's wrist and subsequently dispersing that fluid for application to the hands. By placing the dispenser at this critical part of the anatomy several benefits are immediately apparent: it is always at hand for instant use; it is close at hand to the point of application; its very presents on the wrist reminds the user to use the fluid; it takes no time to retrieve and return to pocket; and it requires no walking to and from a distant dispenser. These numerous at hand advantages have given that invention its name, the AtHand .TM. system. Compliance monitoring of the AtHand .TM. system utilizes a method that often relies upon several distinct advantages made possible by that system's unique characteristics To better understand how distinct theses advantages are it is beneficial to review the prior art of hand hygiene compliance monitoring as described in the United States patent literature. There have been numerous devices and methods developed for monitoring hand hygiene compliance, most in the last ten years. Eight patents that are representative and relevant in some manner defining the current art are as follows:
Knippscheer U.S. Pat. No. 5,202,666 disclosed a system where an employee wears a nametag that is sensed when the employee enters a washroom and again is sensed when leaving the washroom. A third sensing is created if an employee washes their hands. If the employee is sensed leaving the washroom without a hand-washing signal a command is issued to wash, their badge blinks, a computer record is made or a combination of such actions occurs.Shaw U.S. Pat. No. 5,812,059 disclosed a reverse variation of Knippscheer '666 where the sensing zone is moved from the washroom to a designated clean area. When an employee wearing a transmitting badge enters or leaves and reenters a clean zone they are required to use a washstand in the clean area in a timely fashion or be tagged for non-compliance.Segal U.S. Pat. No. 5,793,653 disclosed a hand sink equipped with and its water controlled by an ID input unit that records a time stamp and duration of use by the user. By networking many sinks a compliance profile on an individual is created for management review and action.Gorra U.S. Pat. No. 5,945,910 disclosed a system where the compliance monitoring is placed in the washstation's dispenser of cleaning agents. The employee inputs their identification code and the dispenser's data module adds a time/date stamp creating an electronic record for later administrator collection, review, and action.Segal U.S. Pat. No. 6,236,953 disclosed a washstation control system that operates on validating predetermined operating parameters of a given user. A communicating monitoring device capable of detecting and controlling water, cleaner dispenser use, and blower functions enforces compliance by data records and audio non-compliance warnings.Velasco U.S. Pat. No. 6,278,372 disclosed an electronic badge that is capable of emitting a light which darkens, blinks or emits a sound if the badge is not reset after a predetermined time by the wearer when prompted to wash their hands.Thompson U.S. Pat. No. 6,404,837 disclosed a hand soap dispensing unit that has a self-contained keypad/display module capable of recording a user's input identification code and storing data for later management extract and use.Levy U.S. Pat. No. 6,426,701 disclosed an electronic badge activated by a beacon placed in a contaminated area. The wearer must wash their hands in an area covered by a deactivating beacon to deactivate the badge's contamination signal output.
The above described current practices, known expressions of these inventions in the marketplace, and all other known forms of compliance monitoring are all deficient is several respects. Significantly, none of the above references taken in part or as a whole present a convenient, timely, and effective way of facilitating hand hygiene other than those where a remote washstation is a key component in achieving the compliance goal. However organized, each invention includes a step of traveling to a predetermined physical place to perform an ablutionary act as a key action to be somehow sensed for compliance monitoring purposes. The instant invention is the first of a new class of compliance methods to move the sanitizing function to the person, worn or carried in some fashion by that person, and a physical record of those hand cleanings created at the moment of use whereby compliance monitoring is possible both instantly now and cumulatively later. As the literature has clearly and repeatedly stated, the biggest problem with achieving compliance regardless of the coercive tactics set to measure that compliance is to adequately address the issues of time and convenience first. To develop a technically successful sensing system monitoring compliance without also meeting the overarching need for sanitary hands at an operationally affordable price is simply missing the point. One report has estimated that nearly 20% of a staff nurse's time would be spent hand washing if a full regime of conventional washing compliance were followed; no healthcare facility could afford such a drain of staff time and money. Not only is the cost of the monitoring system largely wasted, but the very records it creates become a corporate liability in subsequent legal actions where failure to follow establish hygienic protocols becomes an issue. No system represented in the current art actually makes time and convenience the essential element of their compliance monitoring system. The AtHand .TM. system of hand sanitation with its built-in compliance monitoring features represents a new branch in the current state of the art.